01:16pm Monday 25 September 2017

Malaria fever therapy: Wide-spread administration in Vienna was an exceptional case – Medical University of Vienna presents results from the Historical Commission

The primary result: The malaria fever therapy was an exceptional case in terms of its cross-diagnosis, widespread administration at the Wiener Klinik (Vienna Clinic), but was permissible seen from the perspectives of that time. There are however indications that, in individual cases, the preservation of the malaria strain was the focus of importance.

Gernot Heiss/© MedUni Wien - HinterramskoglerWolfgang Schütz/© MedUni Wien - HinterramskoglerJohannes Wancata/© MedUni Wien - Hinterramskogler


The investigation by the independent Commission, headed by the historian Gernot Heiss, is concentrated on those diagnoses made at the Wiener Klinik, at the time managed by Hans Hoff (1951 – 1969), which sometimes also led to deployment of the malaria fever therapy. These are the five former diagnosis fields “neurosyphilis”, “schizophrenic” and “affective diseases”, “lack of intelligence” and “psychopathy”. “In comparison to other clinics, this was a far wider field of application which was reasoned by the positive experiences attested by the doctors during treatment in the 1920s to 1940s”, explains Heiss.

In the years between 1951 and 1969, psychiatric practice was undergoing an international phase of successive transition from the therapies developed between the war years to the new psychotropic drugs. During this period of “pharmacological change” in psychiatry, the “shock and fever cures” (malaria fever therapy, insulin coma therapy, metrazol shock therapy, electroconvulsive therapy) introduced in the 20’s and 30’s were continued in parallel with or in combination with the new drug therapies (from 1952 neuroleptics, from 1958 antidepressants), whereby their use as accepted by the psychiatric “Scientific Community” was determined not only by scientific discussion, but also by the personal experiences made by doctors.

With regard to this, Gernot Heiss states: “There are no indications that the malaria fever therapy or one of the other therapies were deployed for ‘testing purposes’ or as punishment”.
“The malaria infection was always transmitted through blood transfer of the ‘malaria tertiana‘ from human to human, whereby the infection could be ended without a risk of malaria relapses, i.e. renewed outbreaks of malaria fever”, explains Johannes Wancata, psychiatrist and member of the Advisory Board. However, this also means that the strain had to be passed on from patient to patient in order for it to survive. “In individual patient files, comments can be found such as “comes as strain carrier”, from which one could interpret that these patients were primarily treated as the carriers of malaria tertiana”, says Wancata. It cannot therefore be excluded that in individual cases the application of the malaria therapy may have been justified in terms of the general diagnosis, but was in fact primarily used to maintain the malaria tertiana strain. Wancata emphasises that such a procedure is clearly to be rejected from today’s perspectives: “As the Director of one of the subsequent facilities to the former Neurologisch-Psychiatrischen Universitätsklinik, I regret these measures formerly executed”.

Overall, the Commission, consisting of Heiss and the former patient’s ombudsman of the City of Vienna, Konrad Brustbauer, the medical law expert Christian Kopetzki and the historians Mitchell Ash, Margarete Grandner, Gabriella Hauch and Oliver Rathkolb investigated during the course of the two-year research project approximately 90,000 patient files, which are available in the archive of the General Hospital. All those cases in which one of the five diagnoses was made along with an in-patient stay of at least five days were recorded in the database for statistical assessment, as it could be assumed that none of the investigated treatments could have been conducted during a shorter stay. Therefore, 14,919 files from the adult wards were entered into the database; of these 772 cases featured the application of the malaria fever therapy. Of the approx. 2,400 files from the children’s ward, a total of 35 cases involved malaria therapy, whereby none of the children had come from a Children’s Home.

According to knowledge obtained by the Commission, in Vienna the malaria therapy was used for longest into the 1960’s within the German-speaking regions. Heiss: “This wasn’t because they had fallen behind in terms of pharmacological developments, but was rather purely because Vienna’s clinicians – above all Hans Hoff and his generation – had gained positive experiences with this therapy, and because Vienna had a malaria strain at its disposal for longer than elsewhere”.

About the malaria fever therapy
The malaria fever therapy was deployed worldwide from the 1920’s to the 1960’s, mainly against the later psychiatric-neurological stages of syphilis, and was also deployed for other diseases in the field of psychiatry. Here patients were purposely infected with a malaria pathogen which could easily be treated in order to abate the symptoms of a disease through the severe attacks of fever. The malaria therapy was considered a superior therapy even to the use of antibiotics for progressive paralysis, a late stage of syphilis.

The work conducted by the Historical Commission has been supported by the “Bürgermeisterfonds” (Mayoral funds) of the City of Vienna to the sum of EUR 107,000 and the Jubiläumsfonds (Anniversary funds) of the Österreichischen Nationalbank (Austrian National bank) to the sum of EUR 101,000. A comprehensive publication in the form of a book is to be published at the beginning of 2016.




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